In the health insurance, domiciliary hospitalization means medical treatment which is done at home. It includes treatment for a period exceeding three days for the illness/injury which is in normal course need treatment at the hospital/nursing home but which is actually taken at home under any of the below circumstances-
- The patient’s condition is such that he/she is unable to go to the hospital/nursing home, or
- It is not possible to take patient to the hospital/nursing home due to lack of accommodation.
However, this benefit does not include following-
- Any such expense which is incurred for pre and post hospitalization
- Any expense which is incurred on the treatment of any of the ailments-
- Chronic nephritis
- Diabetes mellitus and insipidus
- Influenza, cold and cough
- All psychiatric or psychosomatic disorder
- Pyrexia of unknown origin for less than ten days
- Arthritis, gout and rheumatism
- Tonsillitis and upper respiratory tract infection, which include larynigitis and pharyngitis
- Under the aforesaid policy, any of the ailments means that continuous period of ailments and it comprises of relapses within the period of 45 days from the last day of consultation with the nursing home/hospital, where the patient has taken the treatment. If there is the occurrence of same illness after a lapse of 45 days then it will be considered as fresh ailment for this purpose of the health policy.
There are some exclusions to the domiciliary hospitalization, which are-
No claim will be given by the insurer in respect of the following case-
- All ailments/injuries which are pre-existing before taking the health insurance coverage by the policyholder.
- Most of the health insurance companies do not cover cost of hearing aids, spectacles and contact lenses.
- Generally, health insurers do not cover dental treatment or surgery, which is done for beautification.
- Various medical conditions which are referred as AIDS.
- Expenditure on tonics and vitamins unless it forms part of the medical treatment.
- Such treatment which arise from pregnancy (inclusive of voluntary pregnancy termination) and childbirth (inclusive of caesarian).
- Naturopathy treatment.
- Medical expenditure incurred on nursing home, hospital, mainly for diagnostic, laboratory examinations, X-ray or for other diagnostic studies or presence of any such disease ,sickness or injury for which hospitalization is necessary or at a home which is defined under domiciliary hospitalization.
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